Medical simulation system and method

ABSTRACT

A portable medical simulation system and method employs an artificial patient with a built-in haptic interface device, with up to four carriages for engaging different diameter catheters. A catheter stabilizer between each carriage expands and contracts in an accordion fashion as the carriages move in relation to each other, preventing the catheter from bending and bowing. A contrast display visual effect derived from a particle emitter software tool simulates the release of radiopaque dye within a simulated vasculature system for display on a monitor. A computer software based system is used for generating haptic effects on the catheter through control signals passed to each of the carriage motors controlling translation movement of the catheter and magnetic particle brakes controlling rotational movement of the catheter.

CROSS REFERENCE TO RELATED APPLICATION

This application claims the benefit of U.S. Provisional Application No.60/579,504, filed on Jun. 14, 2004, titled “Medical Simulation SystemAnd Method”, and this application is related to a co-pending patentapplication titled “3D Visual Effect Creation System And Method” andfiled on the same day herewith which is licensed by the same assignee ofthis invention.

FIELD OF THE INVENTION

This invention relates to the field of simulations for medical training,and more particularly, to an enhanced method and system for traininghealthcare teams.

BACKGROUND OF THE INVENTION

Healthcare education leaders have seen the need for simulation systemsthat efficiently train, evaluate, and enhance individual medicalpractitioner's skills to improve patient outcomes. In a recent survey,73 of the 124 US medical schools are using some form of computersimulation for student evaluation. The development of simulation andtraining centers for the cognitive training of healthcare professionalsin the practice of interventional medical procedures represents asignificant advance in being able to promote the best demonstratedpractices in the use of existing and new products and procedures. Theintroduction rate of new therapeutic devices and procedures isaccelerating such that the lifecycle of a new product can be as short aseighteen months. At the same time the American College of Cardiology(“ACC”) reports that 50% of the 10,000 interventional cardiologists donot meet the minimum standards for procedure competency. Currenttraining methodology cannot address these problems. The answer is broadaccess to cognitive training and education on an industry wide universalplatform that the present invention provides.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a perspective view of an exemplary embodiment of theportable medical simulation system for training healthcare teams of thepresent invention.

FIG. 2 shows a perspective view of an exemplary embodiment of theportable medical simulation system of FIG. 1 in a collapsed state readyfor transport of the present invention.

FIG. 3 shows a perspective view of the haptic interface device in anembodiment of the portable medical simulation system for traininghealthcare teams of the present invention.

FIG. 4 shows a front perspective view of a carriage within the hapticinterface device in an embodiment of the portable medical simulationsystem for training healthcare teams of the present invention.

FIG. 5 shows a rear perspective view of the carriage of FIG. 4 in anembodiment of the portable medical simulation system for traininghealthcare teams of the present invention.

FIG. 6 shows a side view/hidden view of the carriage of FIG. 4 in anembodiment of the portable medical simulation system for traininghealthcare teams of the present invention.

FIG. 7 shows a top plan view of the carriage printed circuit board ofFIGS. 4, 5, and 6 in an embodiment of the portable medical simulationsystem for training healthcare teams of the present invention.

FIGS. 8A, 8B, 8C, and 8D show various views of an embodiment of thecatheter stabilizer within the haptic interface device in an embodimentof the portable medical simulation system for training healthcare teamsof the present invention.

FIGS. 9A, 9B, 9C, and 9D show various views of an alternative embodimentof the catheter stabilizer within the haptic interface device in anembodiment of the portable medical simulation system for traininghealthcare teams of the present invention.

FIG. 10 shows a schematic electrical diagram of the printed circuitboard of the haptic interface device in an embodiment of the portablemedical simulation system for training healthcare teams of the presentinvention.

FIG. 11 shows a block diagram of the relationship between the hardwarecomponents in an embodiment of the portable medical simulation systemfor training healthcare teams of the present invention.

FIGS. 12-20 show representations of a contrast display visual effectderived from a particle emitter software tool that simulates the releaseof radiopaque dye within a simulated vasculature system for display on adisplay device in an embodiment of the portable medical simulationsystem for training healthcare teams of the present invention.

DETAILED DESCRIPTION OF THE INVENTION

Referring now to the Figures, in which like reference numerals and namesrefer to structurally and/or functionally similar elements thereof, FIG.1 shows a perspective view of an exemplary embodiment of the portablemedical simulation system for training healthcare teams of the presentinvention. Referring now to FIG. 1, Simulation System 100 provides anindustry platform, a standard for technical parameters, skill assessmentand measurement, and communications capability. A unique aspect of theinvention is the use of Artificial Patient 106 for cognitive trainingand decision making. Prior art, such as U.S. Pat. No. 6,074,213, grantedto David C. Hon on Jun. 13, 2000, describes a procedural training systemthat is an event driven state model that utilizes a rule-based expertsystem that is resident at each workstation. The medical simulationmethod and system for training healthcare teams of the present inventionutilizes Artificial Patient 106 where the attributes of the simulatedpatient's anatomy, disease state, and the decisions and selections ofthe team member interact in both a deliberate and random manor, as in areal patient, to produce unpredictable outcomes. Even though a teammember may properly execute a medical procedure, other complications asa result or related to the procedure, anatomy, disease state, medicaldevice, or drug agent could result in an adverse event and a negativeoutcome. Conversely, if a team member initially experiences an adverseevent but recognizes the implications of the event and implementsappropriate corrective action, a negative outcome can be avoided.Through the use of Artificial Patient 106 the team member is trained andevaluated in the proficiency of their cognitive skills for treating thepatient, not just their skills in performing medical procedures.

A network of Simulation Systems 100 located across the country canprovide a cost-effective platform for medical device manufacturers,medical societies, hospitals, and educational institutions to distributetheir cognitive training products to healthcare industry personnel. Astandardized design and layout of each Simulation System 100 ensuresthat courseware that is developed at one Simulation System 100 locationcan be consistently utilized at other Simulation System 100 locations,providing the highest quality and most effective education. Universalstandards will create a level playing field for all stakeholders.Medical personnel will have access to training on a daily basis ifneeded. Field sales people can host selected physicians at a localSimulation System 100 without incurring undue travel cost and time.Product adoption can occur in a matter of months nationally andinternationally. Universal standards created for training and skillassessment can be measured and gauged. Each Simulation System 100 isdesigned to run courseware developed from a variety of differentinformation sources including, but not limited to, medical devicecompanies, medical societies, accreditation organizations, medicalschools, medical centers who advance development of new procedures andtherapies, and prominent industry authors. Simulation System 100 can beutilized to introduce new products, demonstrate difficult procedures,evaluate the effectiveness of new procedures, evaluate the effectivenessof team training, health care professional credentialing, and theeffectiveness of hospital training programs.

Simulation System 100 may be used to establish uniform standards for thedevelopment of interactive training courseware and provide comprehensiveand objective databases on the performance of medical operators, healthcare support personnel, and medical institutions. The database mayprovide feedback on the results of courseware for new health careproducts and procedures. The uniform standards and database may providefor both general information for all participants and proprietaryinformation to individual participants, such as medical devicemanufacturers.

Simulation training utilizing Artificial Patient 106 is not simply anextension of traditional training methodology, but rather is asignificant new tool for the medical industry. This tool has thebuilt-in capability to consistently train healthcare professionals inthe best-demonstrated practice and in the use of the product to achievethe highest probability of producing a successful outcome. In addition,the system evaluates individuals and teams of healthcare professionalsin state-of-the-art medical procedures, knowledge, cognitive skills, anddocuments their performance of the simulated procedures. Cognitiveskills can be gained from real life experience and from good simulationexperience. Real life experiences are subject to many risks as opposedto simulation experiences, which have far fewer risks.

The aviation field, with its outstanding safety record, has learned thatto provide true cognitive training you must address four key teachingelements: manual dexterity skills, perceptual skills, fund of knowledge,and decision making. Together, these four elements are combined into adynamic learning process that exposes the participant to a variety ofsituations that builds depth of experience that cannot be gained inroutine practice. Simulation improves decision making on the part of theparticipant, compared to traditional training methodology, because theconsequences resulting from the interaction with the simulationinterfaces are fed back to the participant immediately, just as in reallife situations, forcing acceptance and/or resolution of problems inreal-time. The commercial aviation field now relies on simulationtraining to the extent that commercially qualified pilots who aretrained in simulators are certified to fly aircraft that aretransporting revenue-paying passengers upon completion of training incertified simulation training facilities.

The parallels between the challenges of training pilots and physicianshave been recognized by the medical societies. The American College ofCardiology, the Society for Cardiovascular Angiography andInterventions, the Society for Vascular Medicine and Biology, and theSociety for Vascular Surgery have all made firm commitments thatsimulation training must be incorporated into the physician trainingprocess.

The availability of new medical technologies is expanding at anever-increasing rate. This expanding universe of new technologies hascreated a formidable task for individual physicians, nurses, and localhospitals to continuously-maintain their proficiency and provide thebest possible healthcare consistently across the U.S. and around theworld. Recently the Institute of Medicine reported it can take seventeenyears for important medical discoveries to become accepted and used bythe average doctor. On an annual basis, the United States Food and DrugAdministration approves approximately 24 new medical devices forinterventional cardiology alone. The daunting problem faced by medicaldevice manufacturers is how to effectively introduce and train 10,000physicians at 700 key hospitals in a new product every eighteen months.The cost and throughput rate for bringing physicians to formal trainingcenters is so high that medical device manufacturers cannot formallytrain all of their customers. The industry costs resulting fromsub-optimal patient outcomes is estimated to be in the billions ofdollars. In the cardiovascular field alone, a one-percent reduction inthe need for Cardiac Bypass Graft Surgery (“CABG”) would result in a$250 million reduction in healthcare costs to the American public. Asthe case experience of the physician increases, the American College ofCardiology has reported a direct correlation between the successassociated with increased frequency in procedures and decreased risk ofdeath or risk from a CABG procedure. Simulation System 100 is designedto enhance the skills of individual physicians and their teams byincreasing their frequency and exposure to “real patient” clinicalexperiences. Simulation System 100 interactive simulation software isdesigned to introduce specific learning objectives and levels ofcomplexity, or procedural consequences, into simulation courseware.Essential learning objectives can be indexed to higher levels ofcomplexity as the participant masters the new skill or product asdemonstrated by resolving increasingly complex procedural consequences.This unique approach to training, afforded by simulation, controls thebalance between overwhelming a physician or nurse with unrecoverableconsequences against too little training designed to avoid pooroutcomes.

As simulations are performed, metrics are gathered and stored. Metricsare pieces of raw data that indicate competency of the participant.Metrics can be time measurements, amount of substance used measurements,position and force measurements, or test scores from a didactic test.Metrics are quantified and objective, not subjective, measurements ofthe participant's competency. Key metric parameters include basicskills, fund of knowledge, and decision making or process of care. Thesemetrics can assist in assessing the design of new products orprocedures, effectiveness of training programs, and the procedurecompetency of health care professionals. As this data grows, feedbackcan be provided to individual participants. For example, a participantmay have taken six minutes to perform a particular procedure, whereasthe average participant took three minutes. A participant can be shownwhere he or she falls on the curve of all previous participants andimmediately begin corrective measures. Databases of this metric data areextremely valuable. They are very valuable to the individual because theindividual will know where he or she will have to work on improving asprofessionals. The databases are valuable because a hospital will knowhow well a particular individual's performance compares to others, andhow well improvement is progressing where needed. The hospital will beable to assess how well their doctors are doing compared to anotherhospital, and will be able to compare simulation results to the outcomeson actual patients. Doctors can practice very difficult procedures viaSimulation System 100 as well as the procedures that they may only doone or two times in a lifetime. This practice can be done ahead of timeso that the doctor is prepared when a real situation requiring themedical procedure with a real patient arises.

Simulation System 100 may provide on-demand simulation courseware on newproducts and procedures, documentation for hospital-based accreditation,Continuing Medical Education (“CME”) courses, and grand roundsimulations from leading physicians and nurses. Utilizing the metricsgathered over time, services such as health professional accreditationdata and documentation management as well as training documentation forhospital accreditation, malpractice and liability insurance assessmentcan be provided. Simulation System 100 will enable the rapiddistribution of manufacturers' new and existing products usingproprietary simulation courseware and provide on-demand marketinformation on utilization of their products by users.

Simulation System 100 software and training programs besides thereal-time in-room simulations are designed for access and review on theWorld Wide Web. This allows healthcare professionals to access trainingprograms tailored to their training needs around their work schedules.Simulation System 100 and its associated training programs and websiteaccess provides healthcare professionals with a more time-efficient andcost-effective means for maintaining their proficiency. The medicalsimulation method and system for training healthcare teams of thepresent invention is a very efficient, effective, and consistent way toprovide broad-range, on-demand simulation training and educationalproducts. Worldwide access requires a high level of security.Proprietary courseware as well as general information may be distributedselectively. For example, a medical device manufacturer may limitdistribution of new product courseware to approved clinical evaluationfacilities only. Similarly, medical societies can limit distribution ofnew courseware to active members/subscribers.

Simulation System 100 is portable and can be moved to an appropriatelysized room and is preferably set up to resemble an actual medicalenvironment, such as a hospital emergency room, a catheter lab,operating room, etc. Lighting, sounds, medical equipment, and ancillarydevices are designed to create the realism of conducting actualinterventional procedures. Simulation System 100 is capable of providingindividual operator as well as interactive team training. SimulationTable And Stand 102 has an upper portion which supports ArtificialPatient 106 and Haptic Interface Device 104, which is located withinArtificial Patient 106, at a convenient height for the teamparticipants. In one embodiment, Artificial Patient 106 having HapticInterface Device 104 is the SIMANTHA® Interventional Tactile-Force-FeelSimulator, an interactive artificial patient device developed by MedicalSimulation Corporation. Simulation Table And Stand 102 has a lowerportion with caster wheels which enable Simulation System 100 to be veryportable.

Simulation System 100 as shown in FIG. 1 has two Computers 108, (thesecond computer is hidden from view by the first computer and is locatednext to it on the lower portion of Simulation Table And Stand 102).Resident on one or both of Computers 108 are the various softwaremodules that the medical simulations are built from, including asimulation engine module, a virtual team members module, a data managermodule, a metric module, a pre-simulation brief web pages module, atesting module, a database module, and an event handler module. Oneskilled in the art will recognize that more or fewer computers could beutilized in the present invention depending upon the computing power ofthe computer(s), type of simulation system (hospital emergency room, acatheterization lab, operating room, etc.) and the particular medicalprocedure being simulated for training purposes (crash cart,interventional cardiology, interventional radiology, interventionalneurology, arthroscopy, endoscopy, laparoscopy, anesthesia, andintensive and critical care nursing). Regardless of the number, thecomputer(s) and other hardware devices of Simulation System 100 areinterconnected over an Ethernet or other suitable Local Area Network(“LAN”) which may be, but is not limited to, wire, wireless, optical,etc.

Connected between Computers 108 and Haptic Interface Device 104 in oneembodiment of the invention is Haptic Interface Computer 110 (more fullydescribed below in relation to FIG. 11). Haptic Interface Computer 110is located out of view behind the cabinet doors in the storage area ofthe lower portion of Simulation Table And Stand 102.

In one embodiment Simulation System 100 incorporates six differentmonitors to provide visual feedback to team participants and to allowuser input through touch screen capability. From Selection Monitor 112 auser may select which simulation to run and initiate the commands tobegin the simulation utilizing touch screen capability built intoSelection Monitor 112, or the user may select the simulation to runutilizing Keyboard 114 and/or Mouse 116. Keyboard 114 and/or Mouse 116rest on a slide-out tray that can be pushed back in and out of the wayduring the actual simulation.

Selection Monitor 112 is also used to make drug selections necessary forthe simulation, which replicates the function of drug and/or fluiddispensing apparatus. The touch screen allows for fast and direct userinput, and may resemble a real drug dispenser apparatus. The drugdispenser module provides a user interface to requisition drugs and isdisplayed on Selection Monitor 112.

Patient/Mentor Monitor 118 displays at various times during a simulationan animated person, a virtual person. The animated person may be thepatient talking, or a mentor, a doctor, a nurse, or any other individualappropriate for a given medical simulation. The virtual person at thebeginning of the simulation may appear on Patient/Mentor Monitor 118 andthrough audio output tell the team participant(s)about what he or theyare about to do. Patient/Mentor Monitor 118 may also be touch screenenabled. Pre-recorded messages for delivery by the animated person,which may be audio only, audio and video, or video only, are stored inthe database for each different medical simulation. Then, at theappropriate time, the pre-recorded audio, audio/video, or video messageis called and output to the participant through Patient/Monitor 118.

In another embodiment of the invention, various text files associatedwith the simulation selected may be retrieved from the database. Thetext in the files is then synthesized into audio speech, and the virtualperson's image is synchronized with the audio speech such that thevirtual person's lips move, eyes blink, and other facial movements arecoordinated such that the virtual person appears to be talkingnaturally, just as a real person would talk. Thus, three separatetechnologies, 3D graphics modeling and rendering, taking text andconverting it into actual audio, and then combining the 3D graphicsmodeling with the audio, provide a very realistic virtual person. Thisis all done on-the-fly in response to events driven by the participantsduring the simulation. Simulation System 100 has complex rules enginethat are followed based upon the actions of the participant or team ofparticipants. The animated persons appear on Patient/Mentor Monitor 118at various times linked to on-the-fly events. A physician participatingin the simulation may make one decision, and the nurse participating inthe simulation may make another decision based upon the physician'sdecision. The animated person needs to say the right thing based uponthese two independent decisions, and this has to be done on-the-fly.Since the medical team participants will be doing things on-the-fly, thesystem has to be able to respond on-the-fly as well, and will retrievethe appropriate text file for conversion to speech. In addition, some ofthe events are actually random, as opposed to just in response to whatone of the participants did. If a participant makes a bad decision thenworse events may take place. Even if a participant makes good decisionsthe random event could result in a bad event happening. The system doeshave random serious events that happen similar to occurrences in reallife. Thus, the system reaches a level of realism as encountered in reallife.

Road Map Monitor 120 displays stored fluoroscopic images of the patientand serves as the guide to the participant(s) for the simulationprocedure selected. Simulation System 100 utilizes a technique calledTri-Reality Simulation. Tri-Reality Simulation is a hybrid combinationof actual (real) components, virtual components, and simulatedcomponents. A simulated component exists in reality, such as a cathetermanipulated by the physician on Artificial Patient 106 in conjunctionwith Haptic Interface Device 104. Real components may be fluoroscopic,sonographic, MRI, PET, or like images taken from real patients and usedin the simulation through display on Road Map Monitor 120. Renderedimages displayed are the virtual components, such as a rendered image ofa contrast injection displayed on Fluoroscopic Monitor 122.

A still picture selected by the physician from one of the manydiagnostic images presented to the physician at the beginning of asimulation is displayed on Road Map Monitor 120 throughout the medicalprocedure simulation. The selection of the diagnostic image by thephysician is one of the factors the physician is graded on during thesimulation. The better or more optimal the diagnostic view the physicianselects, the better grade the physician will receive for selecting thebetter road map diagnostic image. The graphics module also provides asimulation of fluoroscopic images, sonogram images, MRI, PET, or otherimages of the like in synchronization with the currently runningsimulation.

In typical prior art simulation systems that employ virtual reality,backgrounds for graphic display are being fully volume rendered viasoftware. This full volume rendering increases the computational timeand required hardware resources by a factor of ten to fifteen times overthe Tri-Reality Simulation method of the present invention. Volumerendering everything being displayed with software necessitatesutilizing expensive and high-powered processing hardware to do thenecessary mathematical computations. The present invention uses realfluoroscopic, sonogram, MRI, or PET video images in the background(retrieved from the database), and renders only the medical device, suchas a catheter, being used by the physician in the simulation in theforeground, and the vascular tree if the simulation has called forradiopaque dye. By doing this, the speed of the system is increased wellbeyond the capabilities of prior art systems.

Fluoroscopic Monitor 122 shows simulated live fluoroscopic images ofArtificial Patient 106 in response to the participant who ismanipulating the medical device that interacts with Haptic InterfaceDevice 104. Hemodynamic Monitor 124 displays vital statistics ofArtificial Patient 106 such as blood pressure, O₂ levels, pulse rate,EKG, and other related vital signs or diagnostic outputs.

In one embodiment of the invention, Road Map Monitor 120, FluoroscopicMonitor 122, and Hemodynamic Monitor 124 are attached to a Support Bar126. All three monitors can be raised and lowered by Support Bar 126,and can pivot about Support Bar 126 in order to provide the participantswith a better view of the three monitors. In addition, all threemonitors can individually be swiveled left and right, and tilted forwardand back to aid in positioning each monitor to suit the preference ofthe participant(s).

Equipment Selection Monitor 128 allows the participant to select theparticular medical device, such as a catheter, that the participantbelieves is called for in light of the particular simulation selectedand the corresponding patient problem. Equipment Selection Monitor 128typically has touch screen capability as well. Dual Joy Stick Controller130 simulates for the participant control of a C-Arm device and patienttable panning.

FIG. 2 shows a perspective view of an exemplary embodiment of theportable medical simulation system of FIG. 1 in a collapsed state readyfor transport of the present invention. Referring now to FIG. 2, partsof Artificial Patient 106 are stored in the storage area below the upperportion of Simulation Table And Stand 102. All of the monitors have beencollapsed down and inward on their support columns. The table extensionportion of Simulation Table And Stand 102 has been folded down and DualJoy Stick Controller 130 has been stowed in the storage area. A rigid orflexible top (not shown) can be placed on top of Simulation Table AndStand 102 and secured thereto for short term storage, or fortransportation to a different location, which may be across town oracross the country.

FIG. 3 shows a perspective view of the haptic interface device in anembodiment of the portable medical simulation system for traininghealthcare teams of the present invention. Referring now to FIG. 3, thetop panel and side panels have been removed to show more clearly theinside portions of Haptic Interface Device 104. Haptic Interface Device104 has a wedge-shaped Frame 326, with a Thick End 320 located in thelower body and a Thin End 322 located in the head region of ArtificialPatient 106. This arrangement allows gravity to assist movement of theCarriages 302 when engaged with a Catheter 328. Haptic Interface Device104 is designed to accommodate up to four Carriages 302 which allows upto four different sized catheters to be utilized in a given simulation.Haptic Interface Device 104 may be built with only one, two, or threeCarriages 302 instead of the four as shown for a given intendedapplication.

There are two Drive Motors 308 located at each end of Carriage Bed 306,along with two Idler Pulleys 310. Each Drive Motor 308 and each IdlerPulley 310 are located on the outer edges of Carriage Bed 306, with theRail 304 extending in between. Each Carriage 302 is paired with a DriveMotor 308 located on one end, and an Idler Pulley 310 located on theopposite end and on the same side of Rail 304. A first Drive Belt 444 isattached at a Fore End 440 to a first Drive Belt Pinion 404 on Base 402of a first Carriage 302 (see FIGS. 4 and 5). The first Drive Belt 444 islooped around a first Idler Pulley 310 at Thin End 322, then loopedaround a Fly Wheel 324 of a first Drive Motor 308 located at Thick End320 and on the same side, and the second end of the first Drive Belt 444is attached to a second Drive Belt Pinion 404 of the first Carriage 302.Drive Belt 444 is attached with enough tension such that when the DriveMotor 308 turns its Fly Wheel 324 in either rotational direction, firstCarriage 302 will be translated back and forth along Rail 304 in thedirections indicated by Arrow 312. Thus there are two paired IdlerPulleys 310 and Fly Wheels 324 of Drive Motors 308 on each side of Rail304, and each pair are aligned at a different height from Carriage Bed306 to allow freedom of movement of each Drive Belt 444.

Carriages 302 slide along Rail 304 which is affixed to Carriage Bed 306.From one up to four Carriages 302 may be installed, depending upon thescope of use of a particular Simulation System 100. Drive Motor 308turns its corresponding Fly Wheel 324 rotationally causing Carriage 302to translate back and forth along Rail 304. Once a given simulation hasbeen selected, each Carriage 302 is moved to its starting position.Typically, all Carriages 302 (one, two, three, or four) are moved toThick End 320 and stacked up against each other, with the first Carriage302 butted up against Catheter Support Stand 314. In this position, theCarriages 302 are ready to receive Catheter 328 which is inserted intoCatheter Support Tube 316.

The Carriage 302 that is closest to Catheter Support Stand 314 (thefirst carriage) is designed to engage the largest diameter catheter thatis used in conjunction with Haptic Interface Device 104. The nextCarriage 302 in line (the second carriage) is designed to engage thenext to largest diameter catheter that is used. Similarly, the nextCarriage 302 in line (the third carriage) is designed to engage acatheter whose diameter is smaller than the second carriage, and thelast Carriage 302 (the fourth carriage) is designed to engage thesmallest diameter catheter that is used in conjunction with HapticInterface Device 104. As shown in FIG. 3, Catheter 328 has passedthrough the first Carriage 302 and has engaged the second Carriage 302.

Each Carriage 302 has a Flex Circuit 330 (only one is shown in FIG. 3for simplicity) attached to Carriage Printed Circuit Board 434 at eitherJunction 708 (see FIG. 7). Flex Circuit 330 extends and folds over onitself along Carriage Bed 306 as Carriage 302 is moved back and forthalong Rail 304. The second end of Flex Circuit 330 is fixed to CarriageBed 306 and from there connected to the Haptic Printed Circuit Board 318located under Carriage Bed 306, which is electrically connected toHaptic Interface Computer 110. Positioned between each Carriage 302 andbetween the first Carriage 302 and Catheter Support Stand 314, but notshown in FIG. 3, is a Catheter Stabilizer 804 (see FIG. 8).

FIG. 4 shows a front perspective view, FIG. 5 shows a rear perspectiveview, and FIG. 6 shows a side view/hidden view of a carriage within thehaptic interface device in an embodiment of the portable medicalsimulation system for training healthcare teams of the presentinvention. Referring now to FIGS. 4, 5, and 6, Carriage 302 has Base 402which bolts onto a Block (not visible) that slidably engages with Rail304. Drive Belt 444 attaches to Drive Belt Pinions 404. Brake Bracket406 attaches to Base 402 towards Fore End 440 and secures MagneticParticle Brake 408 thereto. Optical Encoder 436 is attached to Shaft 438of Magnetic Particle Brake 408. Two Flex Beams 410 also attachperpendicularly to Base 402, one at Fore End 440 and one at Aft End 442,and are connected transversely at the top by Cross Member 412. Each FlexBeam 410 has two legs with a lower and upper Thinned Sections 414. FlexBeams 410 are typically made of titanium, and Thinned Sections 414 allowslight bending when Spring Loaded Collet 416 of Carriage 302 comes intocontact with Catheter Support Stand 314 or other Carriages 302. Inanother embodiment, Flex Beams 410 may only have one leg each, with alower and upper Thinned Sections 414.

Spring Loaded Collet 416 is secured between the tops of Flex Beams 410and below Cross Member 412. As shown in FIG. 6, Spring 418 is fullyextended, forcing Circumferential Clamp 420 to engage with the largerOutward Tapered End 454 of Collet 422, all located within the outerhousing of Spring Loaded Collet 416. This is the closed position forSpring Loaded Collet 416 at the beginning of a simulation. The insidediameter of Lumen 452 of Collet 422 is sized to cooperate with one ofthe up to four catheter sizes compatible with a specific SimulationSystem 100. Opening 424 receives the tip of a catheter, and if thecatheter diameter is smaller than the diameter of Lumen 452 of Collet422, the catheter will pass right through Lumen 452 of Collet 422 andout Opening 425 and proceed to the next Carriage 302.

If the catheter is the size that is designed to cooperate with thisCollet 422 in Carriage 302, then upon entering part way through Lumen452, the tip of the catheter will engage the restricted walls of Lumen452. This exerts a force on Spring Loaded Collet 416 which istransferred throughout the structure of Carriage 302. The sensors,electronics, and software controls built into Simulation System 100recognizes this force as an engage catheter state, and the SimulationSystem 100 responds by sending signals to Drive Motor 308 controllingCarriage 302 to force Carriage 302 to move against Catheter SupportStand 314, or an adjacent stationary Carriage 302 as the case may be, inorder to compress Spring 418, allowing Collet 422 to open up, allowingthe catheter to move farther through Lumen 452 of Collet 422. Then, themotion is reversed, causing Spring 418 to decompress, forcingCircumferential Clamp 420 to move along Outward Tapered End 454 ofCollet 422, reducing the inside diameter of Lumen 452, which exerts aclamping force on the tip of Catheter 328, thus securing Catheter 328 toCarriage 302.

In a typical simulation, a small diameter Catheter 328, called a guidewire, may be inserted into Artificial Patient 106 through CatheterSupport Tube 316. Depending upon the simulation, this small diameterCatheter 328 may pass right through the first, second, and thirdCarriages 302 before engaging the fourth Carriage 302. The guide wire issimulated and displayed on Fluoroscopic Monitor 122 as the participantcontinues to push and/or rotate the guide wire. Next, a larger diameterCatheter 328 may be inserted into Artificial Patient 106 over the guidewire such that the guide wire is within a lumen of the larger diameterCatheter 328. This larger diameter Catheter 328 will engage the Carriage302 that is designed to cooperate with the size Collet 422 in itsCarriage 302. As the participant pushes and/or rotates Catheter 328, itis simulated and displayed on Fluoroscopic Monitor 122. The user may nowwant to withdraw the smaller diameter guide wire, and does so by firstpulling on the smaller diameter guide wire, which exerts a force on theSpring Loaded Collet 416 it is engaged with, which is transferredthroughout the structure of that Carriage 302. The sensors, electronics,and software controls built into Simulation System 100 recognizes thisforce as a catheter exchange state, and the Simulation System 100responds by sending signals to Drive Motor 308 controlling that Carriage302 to force Carriage 302 to move against Catheter Support Stand 314, orthe Carriage 302 next to it as the case may be, in order to compressSpring 418, allowing Collet 422 to open up, allowing the smallerdiameter catheter to be released from Collet 422. The user can noweasily remove the smaller diameter catheter from Artificial Patient 106.This removal is also simulated and displayed on Fluoroscopic Monitor122. Thus, by analyzing the forces exerted by the user on the Catheters328 engaging with each Collet 422 in a Carriage 302, the various stagesof the simulation are tracked by Simulation System 100.

Magnetic Particle Brake 408 is used to provide feedback to the user forrotational movement of the Catheter 328 engaged with Collet 422.Magnetic Particle Brake 408 has Gear 426 and Spring Loaded Collet 416has Pulley 428. Timing Belt 446 (shown in cut-away view in FIG. 6) wrapsaround both. Current is applied to Magnetic Particle Brake 408 toincrease resistance to rotation.

Anvils 430 are attached to a top portion of each Flex Beam 410. ForceSensors 432 are attached to either side of an upper portion of BrakeBracket 406. When Spring Loaded Collet 416 moves into Catheter SupportStand 314 or another Carriage 302, Flex Beams 410 will bend at ThinnedSections 414. When viewed from a direction perpendicular to thedirection indicated by Arrow 312, the upper portions of each Flex Beam410 connected by Cross Member 412 and above the upper Thinned Sections414, and the lower portion of each Flex Beam 410 connected to Base 402and below the lower Thinned Sections 414, remain vertical. The middleportion of each Flex Beam 410 located between the Thinned Sections 414,will skew to the left or the right from vertical depending upon whichside of Spring Loaded Collet 416 is being engaged with an adjacentstructure, due to the flexible nature of each upper and lower ThinnedSections 414. Thus, one or the other Anvil 430 will be driven into oneor the other Force Sensor 432. Force Sensors 432 are electricallyconnected to Carriage Printed Circuit Board 434 which is attached toBrake Bracket 406. Flex Circuit 330, Magnetic Particle Brake 408, andOptical Encoder 436 are also electrically connected to Carriage PrintedCircuit Board 434.

In order to protect the Carriages 302 from damage due to severecollisions with each other, a Collision Sensor 448 is mounted onCarriage Printed Circuit Board 434. Collision Arm 450 extends from eachCarriage 302 and is aligned in the direction indicated by Arrow 312. ACollision Arm 450 also extends from Catheter Support Stand 314 to detectimpending collisions with the first Carriage 302. A Collision Sensor 448is also mounted on Thin End 322 of Frame 326 (not shown) to detectcollisions with a collision arm of the fourth (or last) carriage. Thetip of Collision Arm 450 will engage Collision Sensor 448 if theCarriages 302 get too close to each other. Collision Sensor 448 sends asignal that translates to control signals to stop one or the other ofthe Drive Motors 308 to prevent the Carriages 302 from damaging eachother.

FIG. 7 shows a top plan view of the carriage printed circuit board ofFIGS. 4, 5, and 6 in an embodiment of the portable medical simulationsystem for training healthcare teams of the present invention. Referringnow to FIG. 7, Junction 702 provides power to Magnetic Particle Brake408. Junctions 704 are for the two Force Sensors 432. Junction 706 isfor Optical Encoder 436. One or the other of Junction 708 is for FlexCircuit 330, depending upon the location of the particular Carriage 302in relation to the other Carriages 302. Junction 710 is for thetranslation gain, and Junction 712 is for the translation offset.Junction 714 is for Collision Sensor 448.

FIGS. 8A, 8B, 8C, and 8D show various views of an embodiment of thecatheter stabilizer within the haptic interface device in an embodimentof the portable medical simulation system for training healthcare teamsof the present invention. Referring now to FIGS. 8A, 8B, 8C, and 8D, forvery flexible catheters used in the medical simulation, a support meansmust be supplied to keep the catheter from bending and bowing intraversing distances between Carriages 302. Telescoping tubes have beenused in the past as a means of stabilizing the catheter within a hapticdevice. The present invention utilizes Catheter Stabilizer 804 in oneembodiment of the invention to stabilize flexible catheters betweenCarriages 302.

In FIG. 8C, Catheter Stabilizer 804 is shown in a top view in acontracted state typical of when two Carriages 302 are very closetogether. In FIG. 8D, Catheter Stabilizer 804 is shown in a top view inan expanded state typical of when two Carriages 302 are very far apart.The first Catheter Stabilizer 804 is attached on a First End 818 toCatheter Support Stand 314 and attached at its Second End 820 to Aft End442 of a first Carriage 302. The second Catheter Stabilizer 804 isattached on First End 818 to Fore End 440 of the first Carriage 302 andattached at its Second End 820 to an Aft End 442 of a second Carriage302. Thus, as each Carriage 302 moves in relationship to each other,Catheter Stabilizers 804 will expand and contract between them as shown.

Catheter Stabilizer 804 is made from two different sized links that arealternately adhered together at their middle portions to form anexpandable linked structure. Primary Link 802 is shown in a front viewin FIG. 8B, and Secondary Link 800 is shown in a front view in FIG. 8A.Primary Link 802 and Secondary Link 800 are made from a flat piece ofmaterial that is folded twice along Fold Edges 805, 806 and seamed,typically through an overlap between the two ends. The seam may beaccomplished by an adhesive, or through heat welding. In anotherembodiment, the two ends could be butted up against each other and anadhesive strip applied over the abutted ends. In one embodiment of theinvention, Primary Link 802 and Secondary Link 800 are made from a 0.003inch thick Kapton film.

Bottom Edge 808 slides against the top surface of Rail 304. Notches 814engage with Support Rails 822 located on either side of Rail 304 (seeFIGS. 8C and 8D). Thus, Catheter Stabilizer 804 is prevented from movingup and down by Notches 814, Support Rails 822, and Rail 304 as ittranslates back and forth in the direction indicated by Arrow 824.

Catheter Holes 810 and 812 line up with Catheter Support Tube 316 andOpenings 424, 425 in Spring Loaded Collets 416. Thus, a catheterinserted in Catheter Support Tube 316 will pass through each alternatingCatheter Holes 810 and 812 of Catheter Stabilizer 804 before reachingOpening 424 and Lumen 452 in a Spring Loaded Collet 416 of a Carriage302. After exiting the Carriage 302 through Opening 425, the catheterwill pass through each alternating Catheter Holes 810 and 812 of a nextCatheter Stabilizer 804 before reaching Opening 424 and Lumen 452 in aSpring Loaded Collet 416 of a next Carriage 302. Catheter Holes 810 and812 are sized large enough to not impinge on a catheter inserted therethrough when Catheter Stabilizer 804 is in an expanded state. An ovalshaped or oblong shaped hole may be used instead of a circular hole tohelp achieve this end. On either side of Catheter Hole 812 are CollisionArm Holes 816 which allow the Collision Arm 450 on a Carriage 302 topass through in order to engage Collision Sensor 448 on the nextCarriage 302. Since Secondary Links 800 are narrower in width, CollisionArm Holes 816 are not needed for Secondary Links 800.

A predetermined number of alternating Primary Links 802 and SecondaryLinks 800 are adhered together so as to be able to span, in an expandedstate, the maximum distance anticipated between any pair of Carriages302 or between a Carriage 302 and Catheter Support Stand 314 andstabilize the catheter across the separation distance. The reasonSecondary Links 800 are narrower than Primary Links 802 is to allow anoffset area for the Fold Edges 805 to lie when in the contracted state.If Secondary Links 800 and Primary Links 802 are the same width, then inthe compressed state the Fold Edges 805, 806 all line up and tend to fanout due to their thickness and not allow for a tightly compressedstructure.

FIGS. 9A, 9B, 9C, and 9D show various views of an alternative embodimentof the catheter stabilizer within the haptic interface device in anembodiment of the portable medical simulation system for traininghealthcare teams of the present invention. Referring now to FIGS. 9A,9B, 9C, and 9D, in FIG. 9C, Catheter Stabilizer 904 is shown in a topview in a contracted state typical of when two Carriages 302 are veryclose together. In FIG. 9D, Catheter Stabilizer 904 is shown in a topview in an expanded state typical of when two Carriages 302 are very farapart. Catheter Stabilizers 904 are attached to Catheter Support Stand314 and to Carriages 302 as described above. Thus, as each Carriage 302moves in relationship to each other, Catheter Stabilizers 904 willexpand and contract between them as shown.

Catheter Stabilizer 904 is made from two fairly identical strips ofmaterial, Top Strip 900 shown in plan view in FIG. 9A, and Bottom Strip902 shown in plan view in FIG. 9B, the difference being the location ofSlits 919, 920. A series of Slits 919 are cut half way through Top Strip900 from the Bottom Edge 907 upward. A series of Slits 920 are cut halfway through Bottom Strip 902 from the Top Edge 918 downwards. The offsetdistances between each pair of Slits 919, 920 and Fold Lines 905, 906are one of two different distances, and they alternate with each otheralong the length of each strip Top Strip 900 and Bottom Strip 902,smaller, larger, smaller, etc. Top Strip 900 and Bottom Strip 902 arefolded along Fold Lines 905, 906 accordion style, with the first fold ofTop Strip 900 folded opposite to the first fold in Bottom Strip 902. Thetwo strips are then mated along corresponding Slits 919, 920 andinserted together, seating each Slit 919, 920 at its end location toform an expandable linked structure, and forming the criss-cross shapeas seen in FIGS. 9C and 9D. An adhesive tape may be applied to Top Edges918 to add stability to the structure. In one embodiment of theinvention, Top Strip 900 and Bottom Strip 902 are made from a 0.003 inchthick Kapton film.

Bottom Edges 907, 908 slide against the top surface of Rail 304. Notches913, 914 engage with Support Rails 822 located on either side of Rail304. Thus, Catheter Stabilizer 904 is prevented from moving up and downby Notches 914, Support Rails 822, and Rail 304 as it translates backand forth in the direction indicated by Arrow 924.

Catheter Holes 910 and 912 line up with Catheter Support Tube 316 andOpenings 424 in Spring Loaded Collets 416 as described above. CatheterHoles 910 and 912 are sized large enough to not impinge on a catheterinserted there through when Catheter Stabilizer 904 is in an expandedstate. An oval shaped or oblong shaped hole may be used instead of acircular hole to help achieve this end. Collision Arm Holes 915, 916allow the Collision Arm 450 on a Carriage 302 to pass through in orderto engage Collision Sensor 448 on the next Carriage 302.

A predetermined length of Top Strip 900 and Bottom Strip 902 areinserted together so as to be able to span, in an expanded state, themaximum distance anticipated between any pair of Carriages 302 orbetween a Carriage 302 and Catheter Support Stand 314 and stabilize thecatheter across the separation distance. The reason for the differencein width between the Fold Lines 905, 906 and the Slits 919, 920 is toallow an offset area for the alternating Fold Lines 905, 906 to lie inthe compressed state as discussed above.

FIG. 10 shows a schematic electrical diagram of the printed circuitboard of the haptic interface device in an embodiment of the portablemedical simulation system for training healthcare teams of the presentinvention. Referring now to FIG. 10, all of the components of the HapticInterface Device 104 tie into the Schematic Electrical Diagram 1000.

FIG. 11 shows a block diagram of the relationship between the hardwarecomponents in an embodiment of the portable medical simulation systemfor training healthcare teams of the present invention. Referring now toFIG. 11, once a medical simulation has been selected to run, the one ormore Computers 108 send signals of Desired Behavior Data 1102 to theHaptic Interface Computer 110. Haptic Interface Computer 110 sendsPosition and Rotation Data 1104 to Computer(s) 108, and sends Motor andBrake Commands 1106 to Haptic Interface Device 104. Haptic InterfaceDevice 104 sends Position, Force, Rotation, and Collision Data 1108 toHaptic Interface Computer 110.

Within Haptic Interface Computer 110, Haptic Effects Generator 1110processes Desired Behavior Data 1102 and sends Desired Force Data 1112to Force Controller 1114. Force Controller 1114 processes the DesiredForce Data 1112 and generates Motor and Brake Commands 1106 which aresent to Haptic Interface Device 104.

The exception to this process occurs when a catheter exchange event isdetected, in which case a Haptic Effects Off Signal 1116 activatesCatheter Exchange 1118, which in turn sends Catheter Exchange Data 1120to Force Controller 1114. Force Controller 1114 processes the CatheterExchange Data 1120 and generates Motor and Brake Commands 1106 for thecatheter exchange which are sent to Haptic Interface Device 104.

Computer(s) 108 throughout the above processes send Display Signals 1122to the various Monitors, and receives User Input Signals 1124 from theMonitors which are touch screen enabled.

FIGS. 12-20 show representations of a contrast display visual effectderived from a particle emitter software tool that simulates the releaseof radiopaque dye within a simulated vasculature system for display on adisplay device in an embodiment of the portable medical simulationsystem for training healthcare teams of the present invention. Theparticle based contrast software allows for a more realistic visualdisplay of medically simulated contrast. In the past contrast wassimulated by solid shading of the vessel tree in the location of thecontrast (dye) injection. The particle based contrast approach allowsfor physics based particles to be “injected” into a confined vesselspace and react to the vessel walls as it would with actual contrastfluid (dye) in an actual surgical procedure.

The particle based contrast software utilizes a node based hierarchyinteraction where each node in the tree inherits attributes from itsparent node. An emitter node contains all of the physics attributes aswell as the trajectory and velocity attributes that it will apply to itsparticle node children. An emitter node dynamically creates as manyparticle nodes as is necessary for the given simulation. As a particlenode ages it is deactivated and re-used later as needed.

Each node in the particle system can have the following attributes:

-   -   Whether the node is actively being processed;    -   The Fuse or countdown to when this node becomes active;    -   The current age of the node (how long this node has been        active);    -   The position of the node;    -   The size (Scale) of the node;    -   The Color of the node;    -   The Velocity of the node;    -   The Mass of the node;    -   The Display Object associated with this node (if any); and    -   Modifiers that modify children of this node, including:        -   Scale Modifier—changes the size of the particle;        -   Color Modifier—changes the red, green, blue, and alpha            (“RGBA”) color of the particle;        -   Path Modifier—the path that each particle must travel; and        -   Physics modifier—described below.

The emitter node physics modifiers contain the following information:

-   -   Max age—the maximum age for each particle;    -   Age variance—the randomness of the starting age of the particle;    -   Flow direction—the direction of particle flow;    -   Flow angle variance—randomness in the flow direction;    -   Start speed—the starting speed of the particle;    -   Start speed variance—randomness in the start speed;    -   Mass—the mass of the particle;    -   Mass variance—randomness in the mass;    -   Mass growth—rate of change in mass;    -   Gravity—current gravity;    -   Drag—current drag; and    -   Number To Spawn—how many particles to create at each trigger        time.

As a particle is emitted into the vessel tree the emitter physics hasits strongest control over the position and direction of a particle. Theparticle is still restrained to the confines of the vessel wall butotherwise may move freely within it. As the calculated blood flowchanges in the vessel the particle begins to move in the direction ofblood flow and homogenously distributes itself within the vessel wall.Fading down the opacity of the particle and opacifying the vessel wallcreates the homogenous distribution effect. This effect allows for theperception of movement from the particles as well as the dissolvingeffect of the contrast liquid distributing itself inside the vesselwall. As the particle ends its cycle it fades and is deactivated.

The particle based contrast software effect also utilizes the stencilbuffer on the display device to allow the particles to pass slightlyover the edge of the vessel wall and create a “hard edge” as it reachesthe wall. As a particle approaches a branch in the vessel tree theparticle calculates its probability of entering that branch and entersit if the odds allow. Otherwise it continues down the vessel path.

Referring now to FIG. 12, the angle variance from an Emitter Node 1202is defined by the Angle θ. Arrow 1204 represents the direction of flowin the vessel.

Referring now to FIG. 13, the number of Particles 1302 to spawn pertrigger are released from Emitter Node 1202 in directions that varywithin the confines of Angle θ in the direction of flow (Arrow 1204).

Referring now to FIG. 14, each Particle 1302 calculates its currentposition based on its current velocity represented by Arrow 1406, itsacceleration in the direction represented by Arrow 1406, its mass, thedrag in the direction represented by Arrow 1404, and gravity in thedirection represented by Arrow 1402.

Referring now to FIG. 15, each particle interpolates its list ofmodifiers over its specified amount of time after its Fuse Time 1514 haselapsed. For each Particle Lifespan 1502, an Initial Scale 1504 lastsfor a specified period of time, and then a Next Scale 1506 isestablished for another specified period of time, and so on until theend of Particle Lifespan 1502. Likewise, an Initial Color 1508 lasts fora specified period of time, and then a Next Color 1510 is establishedover another specified period of time, and a Next Color 1512, and so onuntil the end of Particle Lifespan 1502.

Referring now to FIG. 16, emitted Particles 1602 are collision detectedand restrained to stay inside the established walls of Vessel 1606 andmove within the direction of flow indicated by Arrow 1604.

Referring now to FIG. 17, once Particle 1702 is emitted from the end ofCatheter 1708, Particle 1702 reacts to the changing flow properties ofthe environment within Vessel 1704. Interpolating in the flow of thevessel, represented by Arrow 1706, slowly takes over the physics of theParticle 1702 until it is moving in the same direction as the flowindicated by Arrow 1706.

Referring now to FIG. 18, as particle opacity decreases, vessel opacityincreases to give the appearance of contrast dispersion. Then, asfurther time passes, both fade to zero opacity.

Referring now to FIG. 19, flow direction and position for newly emittedparticles are updated by the position and direction of Catheter 1708,1708′.

Referring now to FIG. 20, during cannulation, Vessel Back Flow 2002 issimulated by reversing the flow direction of the node emitter. Smallerbranches receive darker vessel shading and particles are still sent downthe Vessel 2004 in the direction of blood flow indicated by Arrow 2008.Based on the vessel size and the simulated volume of contrast injectionfluid, the particles and vessel shading will be lighter to simulate thecontrast dispersion. The particles of Vessel Back Flow 2002 move in thedirection of blood flow indicated by Arrow 2006.

Having described the present invention, it will be understood by thoseskilled in the art that many changes in construction and circuitry andwidely differing embodiments and applications of the invention willsuggest themselves without departing from the scope of the presentinvention.

1. A method for stabilizing a medical device within a haptic interfacedevice, the method comprising the steps of: (a) positioning a firstexpandable linked structure between a first carriages and a supportstand of the haptic interface device, wherein said first expandablelinked structure has a plurality of primary links and a plurality ofsecondary links alternately adhered together at middle portions of eachof said plurality of primary links and said plurality of secondarylinks; (b) receiving the medical device in a support tube attached tosaid support stand; (c) passing the medical device from said supporttube to said first carriage through a plurality of holes in each of saidplurality of primary links and a plurality of holes in each of saidplurality of secondary links of said first expandable linked structure,wherein said plurality of holes in each of said plurality of primarylinks and said plurality of holes in each of said plurality of secondarylinks are aligned together and aligned with said support tube andaligned with an opening in said first carriage; and (d) moving saidfirst carriage a distance away from said support stand, wherein saidfirst expandable linked structure expands and provides stabilizing forceto the medical device across said distance.
 2. The method according toclaim 1 further comprising the step of: slidably engaging a pair ofbottom edges of each of said plurality of primary links and each of saidplurality of secondary links of said first expandable linked structurewith a top surface of a rail of the haptic interface device when saidfirst carriage is moved said distance away from said support stand. 3.The method according to claim 1 further comprising the step of: engaginga first support rail with a plurality of first notches located alongeach of a first fold on a first side of each of said plurality ofprimary links; and engaging a second support rail with a plurality ofsecond notches located along each of a second fold on a second side ofeach of said plurality of primary links; wherein said first and secondsupport rails engaged with said plurality of first notches and saidplurality of second notches prevents said first expandable linkedstructure from moving up and down as said first expandable linkedstructure expands when said first carriage moves said distance away fromsaid support stand.
 4. The method according to claim 1 furthercomprising the step of: receiving a collision arm located on saidsupport stand though a plurality of collision arm holes located in eachof said plurality of primary links and aligned with each other; whereinsaid collision arm engages with a collision sensor on said firstcarriage should said first carriage move too close to said supportstand.
 5. The method according to claim 1 wherein said positioning stepfurther comprises the steps of: attaching a first end of said firstexpandable linked structure to said support stand; and attaching asecond end of said first expandable linked structure to an aft end ofsaid first carriage.
 6. The method according to claim 1 furthercomprising the steps of: positioning a second expandable linkedstructure between said first carriage and a second carriage of thehaptic interface device; attaching a first end of said second expandablelinked structure to said first carriage; and attaching a second end ofsaid second expandable linked structure to an aft end of said secondcarriage.
 7. The method according to claim 6 further comprising the stepof: repeating said steps in claim 6 for a next expandable linkedstructure until all of a plurality of carriages of the haptic interfacedevice have said next expandable linked structure positioned andattached between them.
 8. A method for stabilizing a medical devicewithin a haptic interface device, the method comprising the steps of:(a) positioning an expandable linked structure between each of aplurality of carriages of the haptic interface device and between afirst carriage and a support stand of the haptic interface device,wherein each said expandable linked structure has a first strip and asecond strip folded accordion style and inserted and seated togetherthough a plurality of opposing slits in each of said first and secondstrips; (b) receiving the medical device in a support tube attached tosaid support stand; (c) passing the medical device from said supporttube to a first carriage of said plurality of carriages though aplurality of holes in said first strip and a plurality of holes in saidsecond strip of a first expandable linked structure, wherein saidplurality of holes in said first strip and said plurality of holes insaid second strip are aligned together and aligned with said supporttube and aligned with an opening in said first carriage; and (d) movingsaid first carriage a distance away from said support stand, whereinsaid first expandable linked structure expands and provides stabilizingforce to the medical device across said distance.
 9. The methodaccording to claim 8 further comprising the step of: slidably engaging aplurality of bottom edges of each of said first and second strips ofsaid first expandable linked structure with a top surface of a rail ofthe haptic interface device when said first carriage is moved saiddistance away from said support stand.
 10. The method according to claim8 further comprising the steps of: engaging a first support rail with aplurality of first notches located along each of an outermost fold ofsaid first strip; and engaging a second support rail with a plurality ofsecond notches located along each of an outermost fold of said secondstrip; wherein said first and second support rails engaged with saidplurality of first notches and said plurality of second notches in saidfirst and second strips prevents said first expandable linked structurefrom moving up and down as said first expandable linked structureexpands when said first carriage moves said distance away from saidsupport stand.
 11. The method according to claim 8 further comprisingthe step of: receiving a collision arm located on said support standthough a plurality of collision arm holes located in each of said firstand second strips of said first expandable linked structure wherein saidplurality of collision arm holes are aligned with each other; whereinsaid collision arm engages with a collision sensor on said firstcarriage should said first carriage move too close to said supportstand.
 12. The method according to claim 8 wherein said positioning stepfurther comprises the steps of: attaching a first end of said firstexpandable linked structure to said support stand; and attaching asecond end of said first expandable linked structure to an aft end ofsaid first carriage.
 13. The method according to claim 8 furthercomprising the steps of: positioning a second expandable linkedstructure between said first carriage and a second carriage of thehaptic interface device; attaching a first end of said second expandablelinked structure to a fore end of said first carriage; and attaching asecond end of said second expandable linked structure to an aft end ofsaid second carriage.
 14. The method according to claim 13 furthercomprising the step of: repeating said steps in claim 13 for a nextexpandable linked structure until all of a plurality of carriages of thehaptic interface device have said next expandable linked structurepositioned and attached between them.